背景:利用公司权力破坏公共卫生政策进程的现象越来越被人们所理解;然而,相对较少的奖学金研究倡导者如何利用权力来促进公共卫生政策的成功采用。本文的目的是探讨倡导者如何利用三种形式的权力-结构,工具性和话语性-促进阿根廷通过健康饮食促进法(Ley27,642),迄今为止,引入强制性包装前(FOP)警告标签并规范超加工食品(UPFs)的营销和销售的最全面政策之一。
方法:我们对来自不同部门的倡导者进行了17次半结构化访谈,包括民间社会,国际机构,和政府。数据收集和分析均以Milsom的概念框架为指导,用于分析公共卫生决策中的权力,并使用混合演绎和归纳主题分析对数据进行分析。
结果:倡导者通过利用旋转门来利用结构力量,非正式联盟,和正式的联盟,使他们能够召集决策者讨论空间,战略性地利用有限的资源,并培养多样化的专业知识(例如,研究,营养科学,倡导,法律,政治学,行动主义和沟通)需要通过政策过程的不同阶段来支持法律。倡导者通过收集本地证据的舰队来发挥工具性力量,以促进强有力的政策设计,在他们自己和决策者之间建立技术素养,暴露利益冲突以利用公众压力。倡导者通过采用基于权利的话语行使话语权,包括儿童和青少年以及消费者的透明信息,这使倡导者能够在决策者和公众中树立对法律的良好看法。关键的上下文促成因素包括政治机会窗口,COVID-19大流行,以及从类似政策的区域先例中学习的能力。
结论:公共卫生政策制定,特别是当侵犯公司利益时,其特点是权力严重失衡,阻碍了政策决策。在阿根廷的情况下确定的战略提供了关于倡导者如何利用和行使结构性的重要见解,器乐,以及对抗企业影响并促进成功采用全面的UPF法规的话语权力。
BACKGROUND: The use of corporate power to undermine public health policy processes is increasingly well understood; however, relatively little scholarship examines how advocates can leverage power to promote the successful adoption of public health policies. The objective of this paper is to explore how advocates leveraged three forms of power - structural, instrumental and discursive - to promote the passage of the Promotion of Healthy Eating Law (Ley 27,642) in Argentina, one of the most comprehensive policies to introduce mandatory front-of-package (FOP) warning labels and regulate the marketing and sales of ultra-processed foods (UPFs) adopted to date.
METHODS: We conducted seventeen semi-structured interviews with advocates from different sectors, including civil society, international agencies, and government. Both data collection and analysis were guided by Milsom\'s conceptual framework for analyzing power in public health policymaking, and the data was analyzed using hybrid deductive and inductive thematic analysis.
RESULTS: Advocates harnessed structural power through the leveraging of revolving doors, informal alliances, and formal coalitions, enabling them to convene discussion spaces with decision-makers, make strategic use of limited resources, and cultivate the diverse expertise (e.g., research, nutrition science, advocacy, law, political science, activism and communications) needed to support the law through different phases of the policy process. Advocates wielded instrumental power by amassing an armada of localized evidence to promote robust policy design, building technical literacy amongst themselves and decision-makers, and exposing conflicts of interest to harness public pressure. Advocates exercised discursive power by adopting a rights-based discourse, including of children and adolescents and of consumers to transparent information, which enabled advocates to foster a favorable perception of the law amongst both decision-makers and the public. Key contextual enablers include a political window of opportunity, the COVID-19 pandemic, and the ability to learn from the regional precedent of similar policies.
CONCLUSIONS: Public health policymaking, particularly when encroaching upon corporate interests, is characterized by stark imbalances of power that hinder policy decisions. The strategies identified in the case of Argentina provide important insights as to how advocates might harness and exercise structural, instrumental, and discursive power to counter corporate influence and promote the successful adoption of comprehensive UPF regulation.